Parathyroidectomy Offers Survival Advantage
Surgery decreased the risk of death from any cause by 32% compared with usual treatment.
CHICAGO—Parathyroid surgery reduces the risks of death from cardiovascular and other causes, according to research presented at the American Society of Nephrology's Kidney Week meeting .
In a meta-analysis, David Goldsmith, MBChB, MD, FASN, of Guy's and St. Thomas' Hospitals in London, and colleagues pooled results from 12 observational studies involving 23,731 chronic kidney disease patients with biochemical or clinical secondary hyperparathyroidism (SHPT). All types of parathyroidectomy (PTx) were considered: total PTx with and without autotransplantation and subtotal PTx.
Compared with standard treatment, PTx significantly decreased the risk of death from any cause by 32% in patients with end-stage renal disease. Parathyroid surgery also reduced the risk of death from cardiovascular causes by 39%, according to a separate analysis of 5 studies with 10,000 patients.
“Whilst these observational studies, with their obvious attendant risk of bias, do not unequivocally prove a clinical benefit from parathyroidectomy, this approach might represent a better way to improve the poor outcome of CKD patients, at least in those patients with significant secondary hyperparathyroidism,” co-author Mugurel Apetrii, MD, told Renal & Urology News. “Possible reasons for improved long-term survival following parathyroid surgery include a reduction in cardiovascular disease, better blood pressure control, and decreased use of medications for hyperparathyroidism and hyperphosphatemia, which themselves potentially could increase cardiovascular risk.”
The investigators encouraged a future randomized controlled trial directly comparing PTx with the combination of the oral calcimimetic cinacalcet and vitamin D for important patients outcomes, including major morbidities, mortality, quality of life, and costs.
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